Health Equity International (HEI) started as an informal fundraising effort by members of a Roman Catholic parish in Quincy, Massachusetts, who began making regular trips to Haiti to assist with poverty relief in the early 1980s. In the 2010s, under the leadership of its president and CEO, Conor Shapiro, the St. Boniface Haiti Foundation experienced a period of especially rapid growth. By 2019 its St. Boniface Hospital was the only institution offering tertiary care—i.e., care involving complex medical procedures done by specialists—to southern Haiti’s population of roughly 2.3 million people. In 2019, the St. Boniface Haiti Foundation changed its name to Health Equity International. The change reflected both HEI’s rapid growth and its ambition to have a global impact. HEI had gained a wealth of knowledge and skills from more than three decades of experience in Haiti, but it faced some choices as it considered how to broaden its influence. By 2020, HEI had helped Haiti recover from two major natural disasters in a decade, and when the COVID-19 pandemic struck, it expanded its capacities to help meet the country’s pressing needs. This case asks students to consider the strategic options available to HEI as it seeks to expand its impact.